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EP4285921A2 - Utilisation de cellules t-rapa transduites par lentivecteur pour l'amélioration de troubles lysosomals - Google Patents

Utilisation de cellules t-rapa transduites par lentivecteur pour l'amélioration de troubles lysosomals Download PDF

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EP4285921A2
EP4285921A2 EP23190055.6A EP23190055A EP4285921A2 EP 4285921 A2 EP4285921 A2 EP 4285921A2 EP 23190055 A EP23190055 A EP 23190055A EP 4285921 A2 EP4285921 A2 EP 4285921A2
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cells
transduced
rapa
vector
transgene
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EP4285921A3 (fr
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Jeffrey A. Medin
Daniel H. Fowler
Murtaza S. NAGREE
Tania FELIZARDO
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Medical College of Wisconsin
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Definitions

  • LSD lysosomal storage disorders
  • Fabry disease single protein
  • co-activator proteins an enzyme deficiency and co-activator proteins
  • Lysosomes are membrane-bound organelles in eukaryotic cells that contain more than 60 different enzymes capable of digesting nearly any biomolecule. They carry out many critical biological functions, including acting as the cell's waste disposal system by digesting unwanted materials in the cytoplasm, both from outside of the cell and obsolete components inside the cell. Lysosomal Storage Disorders (LSD) are a group of more than 60 rare inherited metabolic disorders that result from lysosome dysfunction, usually as a consequence of a deficiency in a single enzyme required for the intracellular digestion of lipids, glycoproteins or polysaccharides. As a result of such deficiencies, the molecules that would normally be degraded accumulate inside the cell, leading to dysfunction or death of the cell.
  • LSD Lysosomal Storage Disorders
  • Fabry disease is a LSD resulting from a deficiency in the enzyme ⁇ -galactosidase A ( ⁇ -gal A encoded by the AGA transgene), an enzyme that hydrolyses ⁇ -galactose from glycosphingolipids, in particular globotriaosylceramide (Gbs).
  • ⁇ -galactosidase A ⁇ -gal A encoded by the AGA transgene
  • Gbs globotriaosylceramide
  • ERT enzyme replacement therapy
  • Rombach et al. Orphanet J Rare Dis. 8:47-10.1186/1750-1172-8-47 (2013 )
  • ERT requires lengthy intravenous infusions of recombinant ⁇ -gal A administered every couple of weeks, often at an outpatient center.
  • Fabry patients often require treatment for pain, gastrointestinal dysfunction, arrhythmias and other heart problems, as well as needing blood thinners and blood pressure medications to protect kidney functions.
  • Fabry disease is relatively rare, there are about 4000 patients in the US, treatment costs are on the order of $300,000/year/patient ($1.2 B/year for all US patients).
  • HSCs Hematopoietic stem cells
  • CD34 a cell surface glycoprotein
  • CD34+ HSCs hematopoietic cells
  • CD34+ HSCs have been used experimentally to treat a variety of non-hematopoietic diseases including spinal cord injuries, liver cirrhosis, and peripheral vascular disease.
  • HSCs can be harvested from bone marrow, but may also be harvested from peripheral blood after treatment with certain drugs to 'mobilize' them. Thus, HSCs can be harvested from blood (e.g., by apheresis). HSCs are also "mobile", meaning that they can move from bone marrow into the blood stream to different sites in the body. HSCs can be administered by injection into the blood stream in order to repopulate bone marrow.
  • the inventors have previously used HSCs harvested from Fabry patients to genetically modify the HSCs to produce ⁇ -gal A, the enzyme deficient in patients with Fabry disease. These genetically modified HSCs are infused back into the same patients (autologous grafts) after patients have been "conditioned" by drug regimens to ablate the endogenous HSCs in order to improve the success of the therapy.
  • the genetically modified HSCs Upon re-introduction of the patient's modified cells back into the patient, the genetically modified HSCs will populate all downstream lineages of the hematopoietic system and then circulate throughout the body.
  • the modified cells secrete a form of ⁇ -gal A with a molecular "tag" (mannose-6-phosphate) which enables uncorrected "bystander” cells in the patient to take up and transport the ⁇ -gal A intracellularly into their lysosomes, where they compensate for the patient's ⁇ -gal A deficiency, and effectively degrade the accumulated glycosphingolipids.
  • This method is undergoing clinical trials in Canada (ClinicalTrials.gov #NCT02800070).
  • the core tenet of the prior protocol is that the genetically modified HSCs will differentiate into all possible blood cell (hematopoietic) lineages and circulate throughout the body.
  • hematopoietic blood cell
  • the present invention overcomes the aforementioned drawbacks by providing methods of treating lysosomal storage disorders.
  • the disclosure provides a method of treating a lysosomal storage disorder in a subject, the method comprising the steps of: (a) conditioning T-cells from the subject or suitable donor with rapamycin ex vivo to generate T-Rapa cells; (b) transducing the T-cells in vitro with a vector comprising a transgene of interest that encodes an enzyme associated with a lysosomal storage disorder; and (c) administering the transduced T-Rapa cells to the subject, wherein the T-Rapa cells express the enzyme associated with the lysosomal storage disorder in the subject and reduce one or more symptoms of the lysosomal storage disorder.
  • the method after step (b) comprises expanding the vector-transduced T-Rapa cells by culturing in vitro
  • step (c) comprises administering the transduced and expanded T-Rapa cells to the subject.
  • the disclosure provides a method of treating a lysosomal storage disorder in a subject, the method comprising the steps of: (a) obtaining T-cells from the subject or a suitable donor, (b) conditioning the T-cells with rapamycin ex vivo to generate T-Rapa cells; (c) transducing the T-cells in vitro with a vector that expresses the transgene of interest in the T-Rapa cells; (d) in vitro expanding the vector-transduced T-Rapa cells in culture, and (e) administering T-Rapa cells into the subject, wherein the T-Rapa cells express the transgene of interest in the subject and reduce one or more symptoms of the lysosomal storage disorder.
  • the administering step is by transfusion or intravenous injection.
  • the method further comprises maintaining and expanding the vector-transduced T-Rapa cells in in vitro culture and storing a portion of the vector-transduced T-Rapa cells for future administration to the subject.
  • the disclosure provides a method of producing a population of transduced T-Rapa cells that express an enzyme encoded by a transgene of interest for the treatment of a lysosomal storage disorder, the method comprising: (a) conditioning T-cells from a subject or a suitable donor with rapamycin, producing a population of T-Rapa cells; and (b) transducing the T-Rapa cells in vitro with a vector comprising the transgene of interest to produce a population of transduced T-Rapa cells.
  • This method produces transduced T-Rapa cells able to express the protein (e.g. enzyme) encoded by the transgene of interest.
  • the method further comprises (c) in vitro expanding the vector-transduced T-Rapa cells in culture.
  • the disclosure provides a method of producing a population of transduced T-Rapa cells that express a transgene of interest for the treatment of a lysosomal storage disorder, the method comprising: (a) obtaining T-cells from the subject or a suitable donor, (b) conditioning the T-cells with rapamycin, producing T-Rapa cells; and (c) transducing the T-Rapa cells in vitro with a vector that expresses a transgene of interest in the T-Rapa cell.
  • the method further comprises (d) in vitro expanding the vector-transduced T-Rapa cells in culture.
  • the disclosure provides a method of treating a subject with Fabry disease, the method comprising administering an effective amount of the transduced T-Rapa cells made by the method described herein that express ⁇ -gal A to treat one or more symptoms of Fabry disease.
  • the disclosure provides a population of transduced T-Rapa cells that express a protein encoded by a transgene of interest. In one aspect, the disclosure provides a population of transduced T-Rapa cells that express ⁇ -gal A. In another aspect, the disclosure provides a population of transduced T-Rapa cells that express ⁇ -glucocerebrosidase. In another aspect, the disclosure provides a population of transduced T-Rapa cells that express acid ceramidase. In another aspect, the disclosure provides a population of transduce T-Rapa cells that express acid ⁇ -glucosidase.
  • the disclosure provides a method of treating a subject with Gaucher disease, the method comprising administering an effective amount of the transduced T-Rapa cells that express GBA to treat one or more symptoms of Gaucher disease.
  • the disclosure provides a method of treating a subject with Farber disease, the method comprising administering an effective amount of the transduced T-Rapa cells that express ASAH1 to treat one or more symptoms of Farber disease.
  • the disclosure provides a method of treating a subject with Pompe disease, the method comprising administering an effective amount of the transduced T-Rapa cells that express GAA to treat one or more symptoms of Pompe disease.
  • the disclosure provides a method of treating a subject with a lysosomal storage disorder, the method comprising administering transduced T-Rapa cells expressing a transgene associated with treatment of the lysosomal storage disorder in an effective amount to treat one or more symptom of the lysosomal storage disorder.
  • hematopoietic stem cell Prior methods of using hematopoietic stem cell (HSC)-directed gene therapy are being tested in amenable lysosomal storage deficiencies which are caused by a single enzyme deficiency.
  • HSC hematopoietic stem cell
  • the inventors are currently conducting a phase I clinical trial (NCT02 800070) aimed at treating patients with Fabry disease (FD) by gene transfer.
  • FD is an ⁇ -galactosidase A ( ⁇ -gal A) deficiency in which globotriaosylceramide (Gb 3 ) and other metabolites accumulate.
  • CD34+ hematopoietic cells are transduced ex vivo with a recombinant lentivirus (LV) engineered to overexpress ⁇ -gal A.
  • LV recombinant lentivirus
  • HSCs derived from the vector-transduced HSCs, including leukocytes, can secrete ⁇ -gal A and uncorrected cells within the patient can take up the secreted ⁇ -gal A, a process termed "cross-correction".
  • cross-correction For efficient engraftment, patients receive conditioning regimens (e.g., ablation) that can be problematic.
  • HSCs must be mobilized to peripheral blood with drugs and collected via apheresis.
  • Alternative circulating cell populations that are easier to obtain and transplant are more desirable to use to deliver therapeutic cargo systemically.
  • the present disclosure provides improved methods of treating a lysosomal storage disorders, particularly Fabry disease (Online Mendelian Inheritance in Man (OMIM) ID#301500, Gaucher disease (OMIM ID#230800, 230900, 231000, 231005), Farber disease (OMIM ID#228000), and Pompe disease (OMIM ID#232300)).
  • Fabry disease Online Mendelian Inheritance in Man (OMIM) ID#301500, Gaucher disease (OMIM ID#230800, 230900, 231000, 231005), Farber disease (OMIM ID#228000), and Pompe disease (OMIM ID#232300)
  • Fabry disease Online Mendelian Inheritance in Man
  • Farber disease OMIM ID#228000
  • Pompe disease OMIM ID#232300
  • the present invention describes the use of autologous or donor (non-autologous) CD4 + T-Rapa cells to deliver therapeutic transgene products system
  • an enzyme lacking in the disease, for example, but not limited to, the enzymes ⁇ -gal A for Fabry disease, beta-glucocerebrosidase ( GBA, ⁇ -Glucocerebrosidase, acid ⁇ -glucosidase, D-glucosyl-N-acylsphingosine glucohydrolase, or GCase, which can be used interchangeably) for Gaucher disease, acid ceramidase (encoded by the ASAH1 transgene) for Farber disease, and acid ⁇ -glucosidase (encoded by GAA transgene, also known as acid maltase) for Pompe disease.
  • GBA beta-glucocerebrosidase
  • the present disclosure provides an improved method that uses cells obtained from the peripheral blood (e.g. T-cells) and can provide a population of transduced T-Rapa cells expressing the enzyme that can be stored and infused at any time to boost in vivo circulating transgene-producing T-Rapa cells when needed. Further, the method requires low, if any, ablation to provide efficient engraftment into the subject.
  • T-cells e.g. T-cells
  • T-cells are natural protein-secreting machines and are already employed in many clinical trials. Unlike HSCs, T-cells can be obtained from peripheral blood (PB) without mobilization and can be expanded exponentially in culture. Ex vivo treatment with rapamycin elicits numerous changes in T-cells (e.g., CD4+ T-cells) that, in sum, endow them with a pro-engraftment and anti-apoptotic phenotype. These are termed T-Rapa cells. More about T-Rapa cells can be found in Fowler et al.
  • transduced T-Rapa cells continue to secrete the transgene-product (e.g. enzyme, such as ⁇ -gal A) in the absence of stimulation in vitro.
  • transgene-product e.g. enzyme, such as ⁇ -gal A
  • Transduced and control T-Rapa cells from FD patients and normal donors were xenografted into NOD/SCID/Aga -/- mice (NSF). Higher ⁇ -gal A activity was detected in plasma and organs of mice given LV-modified cells.
  • Vector copy number analyses suggest stable transduction. NSF mice receiving transduced cells also exhibited reduced Gb 3 levels, demonstrating the ability of the enzyme being expressed from the transduced T-Rapa cells to reduce the in vivo substrate target.
  • the Examples demonstrate the in vitro development of lentiviral-transduced T-Rapa cells that can lead to increased enzyme activity and secretion of enzymes from cells. While the Examples demonstrate the use of lentiviral-transduced T-Rapa cells that increase ⁇ -gal A activity which can be used to treat Fabry disease, lentiviral-transduced T-Rapa cells can be used for expressing other enzymes to treat other lysosomal storage disorders, as shown in Fig. 14 and 15 for the transgenes GBA, ASAH1 and GAA.
  • the disclosure provides a method of treating a lysosomal storage disorder in a subject, the method comprising the steps of: (a) conditioning T-cells from the subject or suitable donor with rapamycin ex vivo to generate T-Rapa cells; (b) transducing the T-cells in vitro with a vector comprising a transgene of interest that encodes an enzyme associated with a lysosomal storage disorder; and (c) administering the transduced T-Rapa cells to the subject, wherein the T-Rapa cells express the enzyme associated with a lysosomal storage disorder in the subject and reduce one or more symptoms of the lysosomal storage disorder.
  • the method after step (b) comprises expanding the vector-transduced T-Rapa cells by culturing in vitro before administering the transduced and expanded T-Rapa cells in step (c)
  • Suitable methods of administering the transduced T-Rapa cells include, transfusion and intravenous administration.
  • the disclosure provides a method of treating a lysosomal storage disorder in a subject.
  • the method comprising the steps of: (a) conditioning T-cells with an effective amount of rapamycin ex vivo to produce T-Rapa cells; (b) transducing the T-Rapa cells in vitro with a vector that comprises the transgene of interest that encodes the enzyme associated with the lysosomal storage disease; (c) expanding the vector-transduced T-Rapa cells in in vitro culture, and (d) administering the transduced T-Rapa cells into the subject, wherein the T-Rapa cells express the protein encoded by the transgene of interest in the subject and can subsequently reduce one or more symptoms of the lysosomal storage disorder.
  • the disclosure provides a method of treating a lysosomal storage disorder in a subject.
  • the method comprising the steps of: (a) obtaining T-cells from the subject or a suitable donor, (b) conditioning the T-cells with rapamycin ex vivo to produce T-Rapa cells; (c) transducing the T-Rapa cells in vitro with a vector that expresses the transgene of interest when functionally present in the T-Rapa cells; (d) expanding the vector-transduced T-Rapa cells in in vitro culture, and (e) administering the transduced T-Rapa cells into the subject, wherein the T-Rapa cells express the protein encoded by the transgene of interest in the subject and can subsequently reduce one or more symptoms of the lysosomal storage disorder.
  • obtaining T-cells comprises detecting and isolating CD4+ T-cells from a peripheral blood sample of a subject or suitable donor.
  • Suitable methods of detecting and isolating CD4+ T-cells from peripheral blood are known in the art and include, but are not limited to, for example, flow cytometric cell sorting, including fluorescence-activated cell sorting (FACS), or magnetic separation with the use of magnetic beads that recognize T-cells, including magnet-assisted cell sorting (MACS).
  • FACS fluorescence-activated cell sorting
  • MCS magnet-assisted cell sorting
  • antibodies specific to CD4 that may be, in some examples, attached to magnetic beads, and are used to separate CD4+ T-cells from other cells found in peripheral blood.
  • negative selection can be used to deplete the CD4- cells, allowing for the enrichment of CD4+ cells.
  • the isolated CD4+ T-cells used in the methods are at least about 70% CD4+ (70% pure), more preferably at least about 75% CD4+ (75% pure), alternatively at least about 80% CD4+ (80% pure), alternatively at least about 85% (85% pure), at least about 90% CD4+ (90% pure), at least about 95% CD4+ (95% pure).
  • the CD4+ T-cells are cultured in vitro to expand the cells.
  • the isolated CD4+ T-cells are conditioned/treated with rapamycin to form T-Rapa cells.
  • the T-cells may be conditioned/treated with rapamycin before transduction with the vector comprising the transgene (e.g. AGA, GAA, ASAH1, and GBA transgene) or other appropriate therapeutic construct.
  • the vector comprising the transgene e.g. AGA, GAA, ASAH1, and GBA transgene
  • Methods of conditioning T-cells to form T-Rapa cells is known in the art and described in Fowler et al. 2013, the contents of which are incorporated by reference in its entirety.
  • the isolated T-cells are cultured in chemically defined medium comprising cytokines and rapamycin in a suitable amount to transform the T-cells into rapamycin resistant T-cells (T-Rapa cells).
  • Suitable amounts of rapamycin to transform T-cells into T-Rapa cells include, but are not limited to, a concentration of about 0.1 micromolar to about 2 micromolar, (0.1- 2 ⁇ M), alternatively from about 0.8-1.5 micromolar.
  • Lower concentrations of rapamycin such as 0.1 micromolar can be used; however, lowering the concentration of rapamycin can deteriorate the ability to grow rapamycin-resistant T-cells, and as such, a preferred concentration of rapamycin is about 1 micromolar.
  • Increasing the rapamycin concentration above 1 micromolar has limited feasibility because the drug is not fully solubilized in conventional media above this concentration. As such, concentrations around 1 micromolar are optimal for achievement of the rapamycin resistance (T-Rapa) phenotype.
  • T-Rapa cells are derived, the T-Rapa cells are transduced in vitro with a vector that allows expression of the transgene of interest. Suitable transgenes of interest will depend on the lysosomal storage disorder being treated.
  • vectors are known in the art and contain the necessary elements in order for the gene encoded within the vector to be expressed in the host cell.
  • the term "vector” refers to a nucleic acid molecule or genetic construct capable of transporting another nucleic acid to which it has been linked.
  • plasmid refers to a circular double stranded DNA loop into which additional DNA segments may be ligated, specifically exogenous DNA segments encoding the targeted protein.
  • plasmid refers to a circular double stranded DNA loop into which additional DNA segments may be ligated, specifically exogenous DNA segments encoding the targeted protein.
  • viral vector Another type of vector, wherein additional DNA segments may be ligated into the viral genome.
  • Certain vectors are capable of autonomous replication in a host cell into which they are introduced.
  • vectors can be integrated into the genome of a host cell upon introduction into the host cell, and thereby are replicated along with the host genome (e.g. lentiviral vectors).
  • certain vectors are capable of directing the expression of exogenous genes to which they are operatively linked.
  • Such vectors are referred to herein as "recombinant expression vectors” (or simply, “expression vectors” or “vectors”).
  • vectors of utility in recombinant DNA techniques are often in the form of plasmids.
  • vectors include expression vectors, such as viral vectors (e.g., replication defective retroviruses (including lentiviruses), adenoviruses and adeno-associated viruses), which serve equivalent functions.
  • viral vectors e.g., replication defective retroviruses (including lentiviruses), adenoviruses and adeno-associated viruses
  • Methods of using viral vectors to transduce cells are known in the art along with the methods of producing the viruses to infect or transduce the cells.
  • the vectors are heterogeneous exogenous constructs containing sequences from two or more different sources.
  • Suitable vectors include, but are not limited to, plasmids, expression vectors, lentiviruses (lentiviral vectors), adeno-associated viral vectors (rAAV) among others and includes constructs that are able to express the protein encoded by the gene of interest (e.g. AGA transgene).
  • a preferred vector is a lentiviral vector. Suitable methods of making lentiviral vector particles are known in the art and one embodiment is described in the Examples. While specific lentiviral vectors have been used in the examples, the vectors are not limited to these embodiments and any lentiviral vectors or other vectors capable of expressing the transgene of interest are contemplated for use in the practice of the current invention.
  • a vector can preferably transduce, transform or infect a cell, thereby causing the cell to express the nucleic acids and/or proteins encoded by the vector.
  • the transgene or transgene of interest may be able to express any protein or enzyme that is associated with a disease or disorder, in some instances, the transgene expresses an enzyme or protein associated with a lysosomal storage disorder.
  • Suitable lysosomal storage disorders and suitable transgene of interest to target for the lysosomal storage disorders can be found in Table 1.
  • the lysosomal storage disorder and transgene are selected from Table 1.
  • Lysosomal Disorder Transgene of interest Sequence ID (nucleotide) Fabry disease AGA SEQ ID NO: 1 Gaucher disease GBA SEQ ID NO:7 Farber disease ASAH1 SEQ ID NO:8 Pompe disease GAA SEQ ID NO:9
  • the lysosomal storage disorder is selected from the group consisting of Fabry disease, Gaucher disease, Farber disease, and Pompe disease.
  • the vector is a lentiviral vector containing a transgene for expression of ⁇ -galactosidase A ( ⁇ -gal A) for the treatment of Fabry disease.
  • ⁇ -gal A ⁇ -galactosidase A
  • alpha-gal or ⁇ -gal A are used interchangeably to refer to ⁇ -galactosidase A enzyme (protein).
  • a suitable expression vector includes, for example, a lentiviral vector, for example, pDY/CO. ⁇ -galA (i.e., LV/AGA) (SEQ ID NO:2).
  • the AGA transgene will have at least 80% similarity to the SEQ ID NO: 1, alternatively at least 85% sequence similarity to SEQ ID NO: 1, alternatively at least 90% sequence similarity to SEQ ID NO:1, alternatively at least 95% sequence similarity to SEQ ID NO:1, alternatively at least 98% sequence similarity to SEQ ID NO:1, alternatively at least 99% sequence similarity to SEQ ID NO: 1, alternatively at least 100% sequence similarity to SEQ ID NO:1.
  • Suitable lentiviral vectors for the treatment of Fabry disease include the vector of SEQ ID NO:2, and includes vectors that will have at least 80% similarity to the SEQ ID NO:2, alternatively at least 85% sequence similarity to SEQ ID NO:2, alternatively at least 90% sequence similarity to SEQ ID NO:2, alternatively at least 95% sequence similarity to SEQ ID NO:2, alternatively at least 98% sequence similarity to SEQ ID NO:2, alternatively at least 99% sequence similarity to SEQ ID NO:2, alternatively at least 100% sequence similarity to SEQ ID NO:2.
  • a dual promoter lentiviral vector may be used that allows for the expression of more than one gene of interest.
  • a dual promoter lentiviral vector may express the transgene of interest to treat one lysosomal storage disorder and another protein of interest to treat the same or different disease.
  • the dual promoter lentiviral vector may be able to express the transgene of interest and a second protein that helps to promote the survival or selection of the transduced T-Rapa cells, either in vitro or in vivo.
  • one suitable dual promoter vector is LV/AGA+(IY) (SEQ ID NO:3, FIG. 13B ), as described in Provisional Application No.
  • the T-Rapa cells are transduced with a lentiviral vector as depicted in FIG. 12 .
  • the T-Rapa cells are transduced with a dual promoter lentivirus vector that expresses ⁇ -galactosidase A and a mutant form of inosine-5'-monophosphate dehydrogenase 2 (IMPDH2(IY)) (e.g., vector encoded by SEQ ID NO:3).
  • IMPDH2(IY) inosine-5'-monophosphate dehydrogenase 2
  • lentiviral vector will allow for further enrichment of the transduced T-Rapa cells in vivo in the subject by the treatment of the subject with an effective amount of mycophenolate mofetil (MMF) or mycophenolic acid (MPA) sufficient to enrich the population of lentivirus vector transduced T-Rapa cells in the subject.
  • MMF mycophenolate mofetil
  • MPA mycophenolic acid
  • T-Rapa cells that were transduced are resistant to MPA/MMF.
  • Treatment with low doses of MMF can increase the number of therapeutic T-Rapa, without affecting the original engraftment, while causing minimal or no toxicity.
  • This increases the total number of circulating cells that are expressing and secreting the transgene, for example, ⁇ -galactosidase A, which can lead to better correction of the disease.
  • the current method gives a way to enrich for transduced cells in vivo and allows some gating as to how selective and strong that enrichment is depending on the administration of the MMF.
  • the present methods also allow for cells harboring this lentiviral vector to be enriched for even years down the road to renew the correcting cell population expressing the transgene of interest.
  • the MMF is administered at an effective dosage.
  • An "effective dosage" refers to a dosage that allows for selective enrichment of T-Rapa cells that express the transgene via the lentiviral vector with minimal side effects.
  • the effective dosage is a low dosage. Suitable low dosages include, but are not limited to, for example, 0.1-5 mg/kg body weight given TID (three times a day), alternatively include from about 0.1-3 mg/kg body weight given TID. Alternatively, the effective dose may include higher doses of MMF. Suitable higher dosage of MMF for practice of this invention include MMF in an amount of about 5-10 mg/kg body weight TID (three times a day), alternatively 1000 mg given BID (two times a day).
  • an "effective amount" of MMF will result in a blood concentration within the subject of about 0.4 to about 2 ⁇ M free mycophenolic acid (MPA). Suitable dosages to obtain this blood concentration are readily determined by a physician treating the subject. MMF may also be substituted for mycophenolic acid (MPA) formulations (Myfortic, Novartis, or approved generic).
  • the lysosomal storage disorder is Gaucher disease.
  • Gaucher disease mutations in the GBA gene greatly reduce or eliminate the activity of ⁇ -glucocerebrosidase, which breaks down waxy substances of the lipid class glycosphingolipids called glucocerebrosides into a sugar (glucose) and ceramide, another sphingolipid. Without enough of this enzyme, glucocerebroside and related substances can build up to toxic levels within cells. Tissues and organs are damaged by the abnormal accumulation and storage of these substances, causing the characteristic features of Gaucher disease. Suitable embodiments of the present invention provide for T-Rapa cells expressing GBA for the treatment of Gaucher disease.
  • a lentiviral vector comprises the transgene (e.g., GBA transgene) that allows for expression of ⁇ -Glucocerebrosidase (e.g. GBA transgene found in SEQ ID NO:7) in the transduced cells.
  • GBA transgene e.g., GBA transgene
  • ⁇ -Glucocerebrosidase e.g. GBA transgene found in SEQ ID NO:7
  • the GBA transgene will have at least 80% similarity to the SEQ ID NO:7, alternatively at least 85% sequence similarity to SEQ ID NO:7, alternatively at least 90% sequence similarity to SEQ ID NO:7, alternatively at least 95% sequence similarity to SEQ ID NO:7 alternatively at least 98% sequence similarity to SEQ ID NO:7, alternatively at least 99% sequence similarity to SEQ ID NO:7, alternatively at least 100% sequence similarity to SEQ ID NO:7.
  • the vector is a lentiviral vector that comprises the transgene GBA of SEQ ID NO:7 or a sequence with at least 80% identity to SEQ ID NO:7.
  • Suitable sequence for the lentiviral vector comprising GBA is found in SEQ ID NO:4 and depicted in FIG. 13C , or a sequence that will have at least 75% similarity to SEQ ID NO:4, alternatively at least 80% similarity to the SEQ ID NO:4, alternatively at least 85% sequence similarity to SEQ ID NO:4, alternatively at least 90% sequence similarity to SEQ ID NO:4, alternatively at least 95% sequence similarity to SEQ ID NO:4, alternatively at least 98% sequence similarity to SEQ ID NO:4, alternatively at least 99% sequence similarity to SEQ ID NO:4, alternatively at least 100% sequence similarity to SEQ ID NO:4.
  • Other suitable vectors that encode for the expression of the ⁇ -Glucocerebrosidase protein are contemplated herein.
  • the lysosomal storage disorder is Farber disease (also known as Farber's lipogranulomatosis, ceramidase deficiency, "Fibrocytic dysmucopolysaccharidosis,” and “Lipogranulomatosis”) and the transgene ASAH1 expresses N-Acylsphingosine Amidohydrolase 1 or acid ceramidase (used interchangeably herein).
  • Farber disease also known as Farber's lipogranulomatosis, ceramidase deficiency, "Fibrocytic dysmucopolysaccharidosis,” and “Lipogranulomatosis”
  • ASAH1 expresses N-Acylsphingosine Amidohydrolase 1 or acid ceramidase (used interchangeably herein).
  • Farber disease is an extremely rare autosomal recessive lysosomal storage disorder marked by a deficiency in the enzyme acid ceramidase that causes an accumulation of a waxy class of lipids known as sphingolipids, in particular ceramide, leading to abnormalities in the joints, liver, throat, visceral tissues and central nervous system.
  • Suitable embodiments provide T-Rapa cells expressing N-Acylsphingosine Amidohydrolase 1 for the treatment of Farber disease.
  • Suitable vectors preferably a lentiviral vector, are used to express N-Acylsphingosine Amidohydrolase 1 within the T-Rapa cells.
  • a suitable vector preferably a lentiviral vector can be used to express N-Acylsphingosine Amidohydrolase 1 in the T-Rapa cells.
  • a suitable vector can express N-Acylsphingosine Amidohydrolase 1 using the ASAH1 transgene of SEQ ID NO:8 or a sequence having 80% similarity to SEQ ID NO:8.
  • the ASAH1 transgene will have at least 80% similarity to the SEQ ID NO:8, alternatively at least 85% sequence similarity to SEQ ID NO:8, alternatively at least 90% sequence similarity to SEQ ID NO:8, alternatively at least 95% sequence similarity to SEQ ID NO:8, alternatively at least 98% sequence similarity to SEQ ID NO:8, alternatively at least 99% sequence similarity to SEQ ID NO:8, alternatively at least 100% sequence similarity to SEQ ID NO:8.
  • a suitable lentiviral vector includes the vector depicted in FIG. 13D and in SEQ ID NO:5.
  • Other suitable vectors that encode for the expression of the N-Acylsphingosine Amidohydrolase 1 protein are contemplated herein.
  • the present invention provides vectors and T-Rapa cells expressing acid ⁇ -glucosidase (encoded by the GAA transgene) for the treatment of Pompe disease.
  • Pompe disease is an inherited disorder resulting from the inability to breakdown a complex sugar called glycogen in lysosomes of the body's cells resulting in accumulation of glycogen in certain organs and tissues, especially muscles, which impairs their ability to function normally. Mutations within the GAA gene cause Pompe disease as the GAA gene provides instructions for producing an enzyme called acid ⁇ -glucosidase (also known as acid maltase). This enzyme is active in lysosomes which serve as recycling centers within cells.
  • acid ⁇ -glucosidase also known as acid maltase
  • T-Rapa cells expressing acid ⁇ -glucosidase are used to treat a subject having Pompe disease.
  • vectors, preferably lentiviral vectors can be used to express acid ⁇ -glucosidase via the GAA transgene within the T-Rapa cells for subsequent secretion by them.
  • the vectors, preferably lentiviral vectors comprise the GAA transgene of SEQ ID NO:9 or a sequence at least 80% similar to SEQ ID NO:9.
  • the GAA transgene will have at least 80% similarity to the SEQ ID NO:9, alternatively at least 85% sequence similarity to SEQ ID NO:9, alternatively at least 90% sequence similarity to SEQ ID NO:9, alternatively at least 95% sequence similarity to SEQ ID NO:9, alternatively at least 98% sequence similarity to SEQ ID NO:9, alternatively at least 99% sequence similarity to SEQ ID NO:9, alternatively at least 100% sequence similarity to SEQ ID NO:9.
  • the suitable lentiviral vector is shown in figure 13E and SEQ ID NO:6.
  • Suitable sequence for the lentiviral vector comprising GAA is found in SEQ ID NO:6, or a sequence that will have at least 75% similarity to SEQ ID NO:6, alternatively at least 80% similarity to the SEQ ID NO:6, alternatively at least 85% sequence similarity to SEQ ID NO:6, alternatively at least 90% sequence similarity to SEQ ID NO:6, alternatively at least 95% sequence similarity to SEQ ID NO:6, alternatively at least 98% sequence similarity to SEQ ID NO:6, alternatively at least 99% sequence similarity to SEQ ID NO:6, alternatively at least 100% sequence similarity to SEQ ID NO:6.
  • Other suitable vectors that encode for the expression of a form of acid ⁇ -glucosidase protein are contemplated herein.
  • Percentage of sequence identity or “sequence similarity” is determined by comparing two optimally aligned sequences over a comparison window, wherein the portion of the polynucleotide sequence in the comparison window may comprise substitutions, or additions or deletions ( i.e ., gaps) as compared to the reference sequence (which does not comprise substitutions, additions or deletions) for optimal alignment of the two sequences.
  • the percentage is calculated by determining the number of positions at which the identical nucleic acid base or amino acid residue occurs in both sequences to yield the number of matched positions, dividing the number of matched positions by the total number of positions in the window of comparison and multiplying the result by 100 to yield the percentage of sequence identity.
  • substantially identical or “similarity” of polynucleotide sequences means that a polynucleotide comprises a sequence that has at least 80% sequence identity. Suitable sequence similarity allows for small changes in the transgene that do not affect the function of the protein expressed by the transgene. Alternatively, percent identity can be any integer from 75% to 100%. More preferred embodiments include at least: 75%, 80%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98% or 99% compared to a reference sequence using programs such as BLAST using standard parameters. These values can be appropriately adjusted to determine corresponding identity of proteins encoded by two nucleotide sequences by taking into account codon degeneracy, amino acid similarity, reading frame positioning and the like.
  • Suitable amounts of lentivirus able to transduce T-Rapa cells include, for example, using a MOI (multiplicity of infection) of 1-100, preferably an MOI of 1-30, alternatively 1-60.
  • the T-Rapa cells may be exposed to the lentivirus for 10-24 hours, suitably about 12-16 hours.
  • the T-Rapa cells may be transduced consecutively 1-3 times for exposure times listed herein, suitably 1 time.
  • Cytokines may be added to the culture medium during transduction. After transduction, the cells can be either transferred back into the patient or cryopreserved for later transplantation, or a combination of both. In some instances, the transduced cells may be cultured for a number of days before being transferred or cryopreserved. Suitable methods of cryopreservation are known in the art.
  • vectors are known in the art and can be used to transduce the cell including AAV vectors, and the like. Any vector that is able to allow for stable expression of the enzyme encoded by the transgene of interest is contemplated for use herein.
  • the transduced T-Rapa cells are expanded in culture and cryopreserved at various stages of culture.
  • Suitable methods of cryopreservation include, but are not limited to, suspending the cells in a cryopreservation medium and storing the cells at -80 °C to -196 °C, preferably below -80 ° C.
  • Suitable cryopreservation media are known in the art and may comprise some combination of base medium, cryopreservative (e.g., DMSO) and a protein source.
  • a suitable cryopreservation medium may comprise complete medium and 10% glycerol, complete medium containing 10%DMSO (dimethlysulfoxide), or 45% cell-conditioned medium with 45% fresh medium and 10% glycerol or DMSO.
  • the cryopreservation medium may be serum free, for example, comprises 46.25% cell-conditioned serum-free medium with 46.25% fresh serum-free medium and 7.5% DMSO.
  • Suitable chemically defined medium for culturing T-cells are known in the art and include, but are not limited to, commercial nutrient-rich media such as X-Vivo 20.
  • the chemically defined medium is further supplemented with cytokines.
  • cytokines Preferably, in one embodiment, recombinant human IL-2 (rhu IL-2) and recombinant human IL-4 (rhu IL-4) cytokines are used to supplement the medium.
  • Suitable amount of the recombinant cytokines include about 10-100 IU/mL of IL-2, preferably about 20 IU/mL of IL-2 and about 500-2000 IU/mL of IL-4, preferably about 1000 IU/mL IL-4.
  • the transduced T-Rapa cells are expanded in vitro.
  • the transduced T-Rapa cells may be cultured in chemically defined medium supplemented with cytokines as described herein.
  • the transduced T-Rapa cells may be cultured for at least one day, and suitably may be cultured for at least 2 weeks, alternatively at least 4 weeks, alternatively at least 6 weeks.
  • the transduced T-Rapa cells may be maintained and expanded in vitro in culture for at least 5 passages, alternatively at least 10 passages, alternatively at least 15 passages, alternatively at least 20 passages.
  • the transduced T-Rapa cells may be cryopreserved at any passage after transduction.
  • the present disclosure contemplates populations of transduced T-Rapa cells that express the protein encoded by a transgene of interest and any methods of use thereof.
  • the present disclosure provides a population of transduced T-Rapa cells that express a protein encoded by the transgene of interest.
  • the disclosure provides a population of transduced T-Rapa cells that express ⁇ -gal A.
  • the discourse provides a population of transduced T-Rapa cells that express ⁇ -glucocerebrosidase.
  • the disclosure provides a population of transduced T-Rapa cells that express acid ceramidase.
  • the disclosure provides a population of transduced T-Rapa cells that express acid ⁇ -glucosidase.
  • the transduced T-Rapa cells are administered into the subject having a lysosomal storage disorder in an amount effective to reduce one or more symptoms of the lysosomal storage disorder (e.g. Fabry disease).
  • a lysosomal storage disorder e.g. Fabry disease
  • Suitable methods of administering the transduced T-Rapa cells are known in the art, and include, but are not limited to, intravenous injection and transfusion.
  • the transduced T-Rapa cells may be administered at least once, and suitably will be administered at subsequent times at which increased expression of the enzyme or protein of interest (e.g. ⁇ -gal A expression) are needed to treat one or more symptom of the lysosomal storage disorder (e.g. Fabry disease).
  • the enzyme or protein of interest e.g. ⁇ -gal A expression
  • Fabry disease e.g. Fabry disease
  • subject or “patient” are used interchangeably and refer to a mammalian subject, for example, a mouse, a rat, a monkey, a human, etc.
  • the subject is a human. It is contemplated that the subject or patient may have already been treated with one or more therapies for the lysosomal storage disorder before undergoing the treatment contemplated herein.
  • therapies for the lysosomal storage disorder before undergoing the treatment contemplated herein.
  • patients treated with exogenous enzymes or by prior methods of using transduced HSC cells are contemplated as subjects for use of the present invention.
  • the host cell is suitably a T-cell, for example CD4+ T-cells.
  • a T-cell for example CD4+ T-cells.
  • CD4+ T-cells it may be advantageous to manufacture a mixed population of CD4+ and CD8+ T-cells that secrete the therapeutic protein (transgene of interest).
  • the T-cells are skewed toward Th2 cytokine phenotype, in some embodiments, it may be advantageous to manufacture T-cells skewed towards other phenotypes such as Th1, Th17, or a regulatory T-cell subset.
  • Suitable methods of producing a population of transduced T-Rapa cells are provided herein.
  • the transduced T-Rapa cells are administered to the subject with a pharmaceutically acceptable carrier or excipient.
  • a “pharmaceutically acceptable carrier” means any conventional pharmaceutically acceptable carrier, vehicle, or excipient that is used in the art for production and administration of compositions to a subject.
  • Pharmaceutically acceptable carriers are typically non-toxic, inert, solid or liquid carriers which are physiologically balanced.
  • buffered saline or other saline solutions are physiologically acceptable carriers.
  • Water is not contemplated as a suitable physiologically acceptable carrier.
  • additional components may be added to preserve the structure and function of the T-Rapa cells of the present invention, but are physiologically acceptable for administration to a subject.
  • recitation of a value between 1 and 10 or between 2 and 9 also contemplates a value between 1 and 9 or between 2 and 10. Ranges identified as being "between" two values are inclusive of the end-point values. For example, recitation of a value between 1 and 10 includes the values 1 and 10.
  • aspects of the present disclosure that are described with respect to methods can be utilized in the context of the compositions of matter or kits discussed in this disclosure.
  • aspects of the present disclosure that are described with respect to compositions of matter can be utilized in the context of the methods and kits
  • aspects of the present disclosure that are described with respect to kits can be utilized in the context of the methods and compositions of matter.
  • a DNA fragment comprising the cDNA of the human GLA gene encoding ⁇ -gal A was synthesized by GenScript.
  • the cDNA of the GLA gene was codon-optimized for enhanced expression in human cells.
  • the synthesized DNA fragment was sub-cloned into the 3' self-inactivating (3'SIN), HIV-1-based, lentiviral backbone plasmid pDY.cPPT-EF1a-MCS-WPRE previously generated in our laboratory between the EcoRI and XmaI restriction sites in the multiple cloning site (MCS).
  • the LV particles were produced using HEK293T packaging cells.
  • the packaging cells were expanded to a 4-L culture volume and transiently co-transfected with the LV packaging plasmids (pCMV ⁇ R8.91 (packaging plasmid) and pMD.G (VSV-G envelope encoding plasmid)) and transfer plasmid (pDY/CO.a-gal A).
  • the sequences of those plasmids that were expanded were verified by DNA sequencing.
  • Culture supernatant was harvested twice, yielding a total of 8 L of unconcentrated LV-containing supernatant.
  • the LV-containing supernatant was further purified by Mustang Q ion exchange chromatography, concentrated by tangential flow filtration, and buffer-exchanged into 100 mL GMP-grade Lonza X vivo 20 cell growth medium.
  • VSVg-LVs Vesicular stomatitis virus glycoprotein-pseudotyped lentiviruses
  • HEK293T cells were seeded in 15cm culture dishes and transfected 24 hours later with LV packaging plasmids and transfer plasmid. 16-17 hours later media on the cells was exchanged for fresh media. 24 hours later culture supernatant was collected and replaced with fresh media. A second collection was performed another 24 hours later. The culture supernatant was filtered through 0.22 ⁇ m vacuum-assisted filters, and ultra-centrifuged at 50,000g for 2 and half hours.
  • Residual liquid was removed from the viral pellets, and these were then resuspended in Lonza X Vivo 20 and stored at -80°C until use.
  • Viral supernatants were harvested 24 and 48 hours later and concentrated by ultracentrifugation at 50,000g for 2 hours as depicted in FIG. 11 .
  • Viral stocks were resuspended in lymphocyte culture medium (Lonza X Vivo 20) and stored at -80 °C until use.
  • Sample vials of the final concentrated vector product underwent QC analyses, including vector identity confirmation by Southern blot analysis and titer by p24 ELISA, along with testing for aerobic and anaerobic sterility, mycoplasma levels, endotoxin levels, and residual DNA benzonase levels.
  • FIG. 9 A schematic of making transduced T-Rapa cells is depicted in FIG. 9 .
  • Donor lymphocytes are collected by a 10-liter steady-state apheresis performed prior to stem cell mobilization.
  • CD4 cells were positively selected (Miltenyi; CliniMACSOO device, or laboratory equivalent) and co-stimulated (tosylated magnetic beads [Dynal] conjugated with GMP-grade anti-CD3 [OKT3; Ortho] and GMP-grade anti-CD28 9.3 antibodies [3:1 bead:cell ratio]).
  • donor lymphocytes were obtained as CD34-depleted flow-through from CD34+ cliniMACS procedure from stem cell mobilized donors.
  • CD4+ cells were obtained using magnetic enrichment as previously described.
  • Purified CD4+ cells will be cultured in polyolefin bags (Baxter) using X-VIVO 20 media (Lonza), 5% donor plasma, recombinant human (rhu) IL-4 (1000 I.U./mL; Schering), rhu IL-2 (20 I.U./mL; Chiron) and Sirolimus ® oral solution (Wyeth; 1 ⁇ M) and anti-CD3/CD28 beads (3:1).
  • X-VIVO 20 media Li.U./mL
  • rhu IL-4 1000 I.U./mL
  • Schering recombinant human
  • rhu IL-2 20 I.U./mL
  • Sirolimus ® oral solution Wi-CD3/CD28 beads
  • T-cells will be washed and transduced with lentivirus vector able to express ⁇ -gal A at MOI of 30-60.
  • T-cells will be washed and propagated in supplemented X-VIVO 20
  • T-Rapa cells are cultured, expanded and cryopreserved for use.
  • both T-Rapa cells derived from a healthy donor (ND) and Fabry donor (FD) were efficiently transduced with the lentiviral vector.
  • Example 3 Expression of ⁇ -gal A in T-Rapa cells transduced with LV
  • ⁇ -gal A levels were determined for the transduced T-Rapa cells from healthy and Fabry donors.
  • the specific ⁇ -gal A activity was determined by fluorometric assay as previously described ( Yoshimitsu et al. 2004, PNAS: 942540-2544 ). Briefly, plasma or cell/organ protein extracts were incubated with 4-methylumbelliferyl- ⁇ -D-galactopyranoside (5 mmol/L) in presence of the ⁇ -N-acetylgalactosaminidase inhibitor, N-acetyl-D-galactosamine (100 mmol/L) (Sigma Aldrich, St. Louis, MO).
  • Example 4 In vivo treatment of a mouse model of Fabry Disease.
  • ⁇ -gal A-deficient and immunocompromised Fabry mice (NOD/SCID/Aga -/- ) as described previously (Pacienza et al. 2012) were used to test the in vivo efficacy of using transduced T-Rapa cells for treatment of Fabry disease.
  • NOD/SCID/Aga -/- mice were engrafted with 5 ⁇ 10 5 transduced human T-Rapa cells from either healthy or Fabry donors as depicted in FIG. 6 .
  • ⁇ -gal A activity in the engrafted animals was assayed 4 weeks after xeno-transplant. Liver, spleen heart, kidney, plasma and PB-WBCs were collected.
  • the ability of the transduced T-Rapa cells to reduce substrate in vivo was also assayed.
  • LV/AGA vector-transduced T-Rapa cells derived from healthy and Fabry donors produce and secrete active enzyme in vivo.
  • CD4+ T cells derived from Fabry patients were also transduced with the lentiviral vector encoding ⁇ -gal A as described above.
  • T-Rapa cells from 3 Fabry patients showed ⁇ -gal A activity, and measured enzyme activities both within the cell and in the cellular supernatants as shown in FIG. 17 .
  • This Example demonstrates transduced T-Rapa express and secrete the enzymes necessary to counter lysosomal storage diseases (e.g., ⁇ -gal A and GCase). Further, this Example shows that transduced Fabry patient T-Rapa cells can be manufactured and transduced T-Rapa cells are able to function in vivo to reduce substrate.
  • lysosomal storage diseases e.g., ⁇ -gal A and GCase
  • FIG. 10 depicts a schematic of the overall protocol for treatment of a disorder by the methods described herein, specifically showing the steps for treatment of a lysosomal storage disorder, for example, Fabry disease using transduced T-Rapa cells.
  • a lysosomal storage disorder for example, Fabry disease using transduced T-Rapa cells.
  • CD4+ T-cells are then isolated from peripheral blood using methods known in the art, for example, flow cytometric cell sorting or magnetic cell sorting using antibodies against CD4.
  • CD4+ cells can be similarly isolated from apheresis products, which may be obtained using methods known in the art. Isolated CD4+ cells are cultured in the presence of cytokines (IL-2 and IL-4) as described above in the presence of rapamycin (for example, 1 micromolar) for 3 days.
  • cytokines IL-2 and IL-4
  • rapamycin for example, 1 micromolar
  • the T-Rapa cells are transduced using a lentivirus ex vivo at an MOI of 1-30 or 1-60 for 12-18 hours, after which they are cultured in cytokine-containing medium for an additional 3 days (can be cultured from 3 days to about 1 month).
  • Lymphocyte-specific chemotherapy may consist of the following regimens (although other regimens can be envisioned): (1) fludarabine plus low-dose, daily cyclophosphamide; or (2) pentostatin plus low-dose daily cyclophosphamide.
  • Patients are infused with about 2-10 ⁇ 10 6 /kg transduced T-Rapa cells intravenously. Patients are monitored for expression of ⁇ -gal A. Cell administration may be repeated and cell dosage may be adjusted as recommended by appropriate physician.
  • Example 6 Production of dual promoter lentivirus vectors for use in the present methods
  • the present invention may use dual promoter lentivirus vectors to transfer a transgene (e.g., AGA transgene) and a resistance gene (e.g., IMPDH2(IY)) to confer resistance to a drug (e.g., mycophenolate mofetil (MMF)) into the target T-cell.
  • a dual promoter architecture pDY-DP (SEQ ID NO:10) was designed and constructed using pDY as a backbone using standard molecular biology techniques. Human-derived ubiquitous, constitutive promoters express transgenes of interest.
  • a vector with IMPDH2(IY) expressed from one promoter was constructed, with the ability to insert another transgene of interest from the other promoter (i.e.
  • FIG. 13 show the vector maps of lentiviral vectors used in the present invention.
  • Suitable methods of producing lentiviral vectors are known in the art.
  • a suitable protocol is shown in Figure 11 .
  • Production of lentivirus includes the following steps: (a) Three packaging plasmids, pCMV ⁇ R8.91 ( Zufferey, et al. Nature Biotechnology 15:871-874, 1997 , incorporated by reference), pMD.G ( Naldini et al., Science 272:263-267, 1996 , incorporated by reference) and pAdV (Promega, USA) are mixed in appropriate ratios with a plasmid encoding the transfer vector of interest. These are complexed with polyethylenimine (PEI) and transfected into HEK293T cells. Media is replaced after 16 hours.
  • PEI polyethylenimine
  • Example 7 Exemplary treatment of Fabry disease using dual promoter lentiviral vectors.
  • Fabry patients will be treated as described in Example 5, with the exception that a dual promoter lentiviral vector, for example as described in Example 6 will be used in which the vector in addition to expressing ⁇ -gal A expresses IMPDH2(IY), which presents a growth advantage to transduced T-Rapa cells when the patient is treated with low doses of MMF.
  • a dual promoter lentiviral vector for example as described in Example 6 will be used in which the vector in addition to expressing ⁇ -gal A expresses IMPDH2(IY), which presents a growth advantage to transduced T-Rapa cells when the patient is treated with low doses of MMF.
  • Enrichment can be initiated if required by treatment with mycophenolate mofetil (MMF; CellCept, Roche, or approved generic); transduced T-Rapa cells are resistant to the effects of this drug, providing them with a growth advantage.
  • MMF mycophenolate mofetil
  • a low dose of oral MMF may be effective (0.1-5mg/kg TID) but higher doses (5-10mg/kg TID or 1000mg BID) may also be tolerated, depending on the patient.
  • a blood concentration of 0.4-2 ⁇ M free mycophenolic acid (MPA) is desirable.
  • MMF may be administered for the duration for which increased enzyme activity is desired, and doses adjusted to titrate the activity. MMF may also be substituted for MPA formulations (Myfortic, Novartis, or approved generic).

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